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Laparoscopy and hysteroscopy for fertility
Laparoscopy and hysteroscopy are two different procedures, often confused with each other. Laparoscopy is keyhole surgery through small cuts in the abdomen, used to reach the tubes, ovaries and outer surface of the womb. Hysteroscopy is a thin telescope passed through the cervix, with no cut at all, used to look inside the womb cavity itself. Dr. Mayur Pai performs both himself, in the operating theatre at Pai Hospital, Vaddem, Vasco-da-Gama — the only theatre in the practice.
A fertility problem is often assumed to be purely hormonal — tablets, injections, timing. Quite often it is partly structural instead: something in the shape or condition of the pelvis or the womb that no amount of hormone adjustment will fix. That is where these two procedures come in, and hearing the word "surgery" is understandably frightening. Most of what follows is day-care work, not major surgery.
Two different procedures, often confused
Laparoscopy — looking from outside the womb
A camera and instruments are passed through two or three small cuts in the abdomen, under general anaesthesia. It reaches the fallopian tubes, the ovaries, and the outer surface of the uterus. It is used for endometriosis (tissue like the lining of the womb growing outside it, which often causes pain and can affect fertility), blocked or damaged tubes, ovarian cysts, some fibroids, and pelvic adhesions. Adhesions are scar tissue left behind by earlier surgery or infection, and they can trap an ovary or block a tube without showing up clearly on a routine scan.
Hysteroscopy — looking inside the womb
A thin telescope is passed through the cervix (the neck of the womb), using the passage that is already there. Nothing is cut, anywhere. It is used to find and treat a polyp, a fibroid growing into the cavity, a septum (a wall dividing the cavity, present from birth), or adhesions inside the cavity itself. Many women refuse a hysteroscopy believing it is the same as laparoscopy. It is not: there is no wound to heal, and most women are home the same day.
Why these matter for fertility specifically
Blocked tubes stop egg and sperm meeting naturally, and lower the chances of IUI working. Sometimes laparoscopy can restore an open tube. And sometimes it simply confirms that IVF — which bypasses the tubes altogether — is the honest route forward. Endometriosis can distort the pelvic anatomy and scarring can trap an ovary out of reach of a needle. And a problem inside the cavity — a polyp, a septum, adhesions — can stop even a well-placed embryo from implanting. That is why hysteroscopy is sometimes suggested after cycles that have not worked, or before a frozen embryo transfer.
What the day looks like
Both are done as planned hospital procedures at Vasco, not emergencies. How long you stay depends on what is found and treated on the day — some hysteroscopies are a few hours, start to finish; laparoscopy usually needs longer, sometimes a short hospital stay. You are told what to expect beforehand, and what was actually found and done once you are awake.
Who these help
- Endometriosis causing pain, heavy periods, or unexplained infertility
- Blocked or suspected blocked fallopian tubes
- Pelvic adhesions from a previous surgery or infection
- A polyp, septum, fibroid or adhesion inside the womb cavity
- Repeated implantation failure or recurrent miscarriage, where the cavity has not yet been properly checked
- Unexplained bleeding between periods
Where this is done
Only at Vasco — the practice's own operating theatre, alongside its own embryology laboratory. The consultation and the decision to proceed happen at whichever Heartbeats clinic is nearest you: Panjim, Margao, Mapusa or Vasco.
Questions people ask about surgery
Will I be cut open for a hysteroscopy?
No. Nothing is cut, anywhere. A thin telescope passes through the cervix, using the passage that is already there, so there is no wound and you are usually home the same day.
What does laparoscopy treat that medicine alone cannot?
Structural problems - blocked tubes, endometriosis, pelvic scarring, some ovarian cysts - that hormone tablets or injections cannot correct on their own.
Is laparoscopy the same as a caesarean cut?
No. Laparoscopy uses two or three small keyhole cuts, quite different from the single larger incision of a caesarean.
Do I need laparoscopy before IVF?
Not everyone does. It is suggested only when your history, symptoms or scans point to a problem it would actually help - never as a routine add-on.
Is hysteroscopy needed if my scans look normal?
Sometimes still recommended, particularly after repeated failed transfers or losses, because some findings inside the cavity do not show clearly on a routine ultrasound.
Where is this done, and can I recover near home?
The procedure itself is only done at Vasco, in our own theatre. Follow-up and any further monitoring can be done at whichever clinic is nearest you.
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This page is for general education and is not personal medical advice. Fertility treatment depends on your individual assessment. Please consult a doctor about your own situation. We do not carry out or offer sex determination of any kind, which is prohibited by law in India under the PCPNDT Act.